Healthcare Provider Details

I. General information

NPI: 1295364792
Provider Name (Legal Business Name): KIMBERLY VU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2020
Last Update Date: 02/24/2025
Certification Date: 02/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5282 MEDICAL DR STE 240
SAN ANTONIO TX
78229-4849
US

IV. Provider business mailing address

903 W MARTIN ST # MS 49-2
SAN ANTONIO TX
78207-0903
US

V. Phone/Fax

Practice location:
  • Phone: 210-644-2100
  • Fax: 210-702-4340
Mailing address:
  • Phone: 210-358-5909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberT5485
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: